Provider Demographics
NPI:1548445695
Name:FISHER, TRAVIS D
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:D
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45176-1004
Mailing Address - Country:US
Mailing Address - Phone:513-724-1600
Mailing Address - Fax:513-724-1601
Practice Address - Street 1:331 S 5TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:OH
Practice Address - Zip Code:45176-1004
Practice Address - Country:US
Practice Address - Phone:513-724-1600
Practice Address - Fax:513-724-1601
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2188627Medicaid
OHU84227Medicare UPIN
OH2188627Medicaid